Psychiatric Triage: Pilot put into Practice

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Psychiatric Triage Pilot put into Practice
Presented by Joe Eppling, RN, MN, MS, CRRN,
CNAA, BC Director of Behavioral Health Services
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Health Care Crisis

• Emergency Departments
• Increased utilization of ED
• Utilization of ED as primary care
• 12 increase utilization from 1994-2004
• 18 reduction of ED 1994-2004
• Psychiatric Service
• Decreased funding
• PPS
• Closure of inpatient and outpatient services
• Limited resources

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Health Care Crisis

• Psychiatric Services in an ED
• Challenging environment
• Medical verses Psychiatric emergencies
• Perceptions of the mentally ill
• Presenting at increasing rates
• ED overwhelmed with influx of psych patients
• ED staff little or no training in mental health

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Location
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History

• Mental health crisis no different for EJGH
• More than 125 psychiatric beds closed between
  1999-2004
• Closure of outpatient programs
• Only 14 psychiatrists in the community and
  surrounding area

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History

• According to the Agency for Healthcare Research
  and Quality
• almost one-fourth of adult patients admitted in a
  community hospital is related to mental health or
  substance abuse
• Source www.ahrq.gov (Released April 2007)

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Our Problem

• Increased number of discharges lt 24 hrs
• 30 of total admissions through the ED
• Inappropriate admissions through ED
• PEC patients from outlying hospitals
• Inpatient unit full
• Psychiatric diversion
• Patients being held in the ED

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Developing the Solution

• Multidisciplinary Team Goals
• Provide appropriate and timely care for mentally
  ill patients
• Protect patients and staff from injury
• Streamline current process for admission/transfer
  of psychiatric patients
• Reduce the number of patients admitted less than
  24 hours
• Re-examine the role of the social worker
• Protect the hospital from EMTALA violations

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Pilot

• ED Psych nurse for Admission
• Perform assessments for inpatient need
• Receive orders
• Assist with admission
• Provide clinical info to insurance companies

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Pilot

• ED Psych nurse for EMTALA calls
• Gatekeeper
• Determine bed availability
• Receive clinical information
• Accept or deny transfers
• Coordinate transfers

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Pilot

• ED Psych nurse for Diversion
• Assess for inpatient admission
• Find receiving facility
• Provide necessary clinical
• Assist with transfer to facility

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Pilot

• ED Psych nurse for Discharges
• Assess for non-admission
• Provide Outpatient resources
• Contact private insurance plans
• Make appointments
• Refer to MHC

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Costs

• Projected costs
• Salary of RN (4.2 FTEs)
• Benefits
• Actual costs
• 3.92 RN FTEs
• Benefits (14)
• 11 overtime
• Orientation

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Savings

• 1.6 FTEs of security hours
• 330 Unnecessary admissions
• Take cost of average day multiply by 330

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Katrina and EJ
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Post Katrina

• DHH findings 2005 Data
• Mental illness and substance abuse most prevalent
  in uninsured populations
• Serious mental health conditions one of the top
  five reasons for admission
• Source http//www.dhh.louisiana.gov/offices/publi
  cations.asp?ID288Detail1300

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Post Katrina

• Region 1 Inpatient psychiatric capacity
• Pre Katrina 487 Psychiatric beds
• Post Katrina 190 Psychiatric beds
• Market share analysis for 2006
• EJGH 63 for psychiatric services
• 2006
• 49,558 ED Visits
• 6,951 Psychiatric visits (14)

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Post Katrina
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Outcomes
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Outcomes
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Thank You jeppling_at_ejgh.org [phone]